Contemporary update of cancer control after radical prostatectomy in the UK

Abstract

5Bristol Royal Inf irmary, UK Despite a significant increase of the number of radical prostatectomies (RPs) to treat organ-confined prostate cancer, there is very limited documentation of its oncological outcome in the UK. Pathological stage distribution and changes of outcome have not been audited on a consistent basis. We present the results of a multicentre review of postoperative predictive variables and prostaticspecific antigen (PSA) recurrence after RP for clinically organ-confined disease. In all, 854 patient's notes were audited for staging parameters and follow-up data obtained. Patients with neoadjuvant and adjuvant treatment as well as patients with incomplete data and follow-up were excluded. Median follow-up was 52 months for the remaining 705 patients. The median PSA was 10 ng ml À1 . A large migration towards lower PSA and stage was seen. This translated into improved PSA survival rates. Overall Kaplan -Meier PSA recurrence-free survival probability at 1, 3, 5 and 8 years was 0.83, 0.69, 0.60 and 0.48, respectively. The 5-year PSA recurrence-free survival probability for PSA ranges o4, 4.1 -10, 10.1 -20 and 420 ng ml À1 was 0.82, 0.73, 0.59 and 0.20, respectively (log rank, Po0.0001). PSA recurrence-free survival probabilities for pathological Gleason grade 2 -4, 5 and 6, 7 and 8 -10 at 5 years were 0.84, 0.66, 0.55 and 0.21, respectively (log rank, Po0.0001). Similarly, 5-year PSA recurrence-free survival probabilities for pathological stages T2a, T2b, T3a, T3b and T4 were 0.82, 0.78, 0.48, 0.23 and 0.12, respectively (log rank, P ¼ 0.0012). Oncological outcome after RP has improved over time in the UK. PSA recurrence-free survival estimates are less optimistic compared to quoted survival figures in the literature. Survival figures based on pathological stage and Gleason grade may serve to counsel patients postoperatively and to stratify patients better for adjuvant treatment.

Low nuclear ErbB3 predicts biochemical recurrence in patients with prostate cancer

“…PSMs after RP are often associated with BCR and progression of prostate cancer [4]. According to other reports, only 20% of patients with negative SMs have BCR within 5 years of RP, but 40–50% with PSMs develop BCR 3–5 years after RP [3,4. Although small, the present group of patients was consistent in terms of the risk of BCR and thus representative of the larger subset of patients with prostate cancer with PSMs.…”

“…Recent studies suggested that patients with BCR within 3 years of RP are usually at higher risk of prostate cancer‐specific mortality than those having BCR after this 3‐year threshold [2]. Nearly a third of patients with localized prostate cancer who have RP will have positive surgical margins (PSMs) [3] and about half of these patients will have BCR within 5 years [4]. However, within the subset of patients with PSMs, it is currently difficult to identify patients at high risk of early BCR.…”

Characteristics of incidental prostatic adenocarcinoma in contemporary radical cystoprostatectomy specimens

“…Only 3–5% of the local population undergo PSA screening, compared with more than half of American men. The result of this is the detection of advanced tumours with larger tumour volume, which is also reflected in the results of English radical prostatectomy series [24]. Biological aggressiveness is known to increase with the size of the tumour [25].…”

11C-acetate PET in the early evaluation of prostate cancer recurrence

“…All 15 patients presented one or more of the three high-risk factors [15]. Many patients of this group presented further risk factors [16][17][18], such as histologically positive surgical margins (n=11), invasion of seminal vesicles (n=4), capsular invasion (n=9) or perineural invasion (n=13).…”

“…A consensus statement of the American Joint Committee on Cancer (AJCC) defined advanced T staging (T ≥pT2c), high tumour grades (sum of Gleason score ≥8) and high pre-surgical serum prostatespecific antigen (PSA) values (>20 ng/ml) as the three major risk parameters of prostate cancer [15]. Positive surgical margins, seminal vesicle invasion and capsular involvement represent further risk parameters [16][17][18].…”